Book review – Genetics in the Madhouse: The Unknown History of Human Heredity

Ask most biologists about the history of genetics and they will likely mention Watson and Crick’s 1953 discovery of the double helix structure of DNA or the work of the monk Gregor Mendel that showed a simple form of trait inheritance. Professor of History Theodore M. Porter contends that there is another, largely forgotten side to this story. Long before words such as genetics and genes had been coined, the fledgeling discipline of psychiatry was recording details of patients in mental asylums, collecting vast amounts of data on human heredity. Genetics in the Madhouse is a deep dive into the archives to reveal this little-known history.

“Genetics in the Madhouse: The Unknown History of Human Heredity“, written by Theodore M. Porter, published by Princeton University Press in June 2018 (hardback, 447 pages)

I first saw this book mentioned in Zimmer’s recent book She Has Her Mother’s Laugh: The Powers, Perversions, and Potential of Heredity. One narrative strand that ran through that book was the contribution of mental institutes to ideas of human heredity. Porter here tells that story in three parts, told largely chronologically.

In Europe, large-scale construction of public mental asylums started from the 1800s onwards. In Britain, the 1808 County Asylum Act called for asylums in every British county, while a similar 1838 law in France aimed at asylums in every French département. The intake of new patients quickly became an almost unstoppable tide, with tens if not hundreds of thousands institutionalised. There was much gnashing of teeth and pulling of hair in response, as observers thought the world was literally going crazy.

Almost from the beginning, doctors started recording details of patients upon admission, and from the beginning, heredity was assumed to play a role. Porter has examined archival material around Europe in Norway, Switzerland, and Italy, but especially in Germany, France and the UK, as well as in the USA. He reveals here how doctors initially were taking free-form notes on patient histories and then started tabulating them. Although information was being circulated amongst different institutes in the form of annual reports and new scholarly publications, there was a lack of standardisation. Every asylum had its own preferred method of data recording and was keen to stick to it. The different proposals to standardise recording of patient details are one thread in Porter’s story. Though universal agreement was never reached, the German’s had a good stab at it, collecting standardised data on a national level by the end of the 1800s using a system of cards stored in filing cabinets. Over time, the practice of drawing up pedigree tables became another tool of the trade.

“The intake of new patients quickly became an almost unstoppable tide [and] there was much gnashing of teeth and pulling of hair in response, as observers thought the world was literally going crazy.”

If I read Porter’s book right, heredity of mental disorders was at this point still little more than a supposition based on common-sense observation. Although some of the numbers seemed to bear this out, different countries reported massively different fractions of their population afflicted by certain disorders. This did not go unnoticed at the time, fueling further discussions on methodology and data collection.

The rediscovery of Mendel’s famous crossing experiments with peas (see Mendel’s Legacy: The Origin of Classical Genetics and Gregor Mendel: Planting the Seeds of Genetics) gave a renewed boost to the idea that mental disorders had a genetic underpinning. It seems that claims for the existence of a “gene for (fill in your favourite trait)” have a far longer history than I thought. There was much torturing of data to make them fit the expected Mendelian inheritance patterns. This too became the subject of much criticism and was abandoned again.

However, if plant and animal breeders could select for traits and against others, could we not do the same in humans? From the start, one aim of asylums was to cure patients. But success rates, much fudged in the records, were very poor. Could selective breeding in humans quell the epidemic of mental disorder? And so we stand at the top of the slippery slope of eugenics and the idea of human perfectibility. Before Nazi Germany turned this topic into a chapter of history most people would rather forget about altogether, eugenics became fashionable in the USA, though its methods were no more gentle. Eugenicists took great interest in the data recorded by asylums. Eugenics is a huge topic and Porter only touches on its beginnings, ending his history in the 1930s. Readers might want to turn to, for example, The Oxford Handbook of the History of Eugenics for a fuller picture.

“The rediscovery of Mendel’s [work] gave a renewed boost to the idea that mental disorders had a genetic underpinning […] There was much torturing of data to make them fit the expected Mendelian inheritance patterns”

By the end of the book, I was left with some questions. Coming to this topic as an outsider, I was curious to know: was the perceived outburst of insanity in the 18th and 19th century real or imagined? To paraphrase a well-known saying: if you build asylums, the mentally ill will come. Was this just a symptom of us getting to grips with the scale of mental illness in society? On the other hand, as Porter mentions here, marriages within extended families were not uncommon in remote backwaters, and I don’t think women knew or were advised to avoid excessive alcohol consumption during pregnancy. Today, both are recognized as risk factors that can lead to developmental disorders.

Similarly, Porter contends that all this data collection by asylums was a relevant chapter in the history of genetics. But their reliability and comparability were already questioned back then. Have any of these data actually led to useful insights? Or have the handwavy hunches that heredity was somehow involved merely been confirmed by later work? I lean towards thinking the former. In She Has Her Mother’s Laugh, Zimmer recounts how the metabolic disorder phenylketonuria was identified by studying mentally ill people, but Porter provides no such examples.

Porter previously authored the biography Karl Pearson: The Scientific Life in a Statistical Age, which led to him writing this book. Thus, it comes as no surprise if I say that he is fascinated by statistics. And his interest as a historian here is in methods of data recording, development of statistical techniques, and the accompanying academic discussions. Zimmer, in contrast, painted a more human picture by focusing not on technique and methodology, but on the lives of some of the mental patients that played a large role in this history.

My point with this is that, yes, Genetics in the Madhouse is well written, fascinating in places, but I cannot deny that its subject matter is quite arcane. General readers might want to start with Zimmer’s book before venturing further. However, readers interested in the history of science, specifically that of psychiatry or genetics, should seek this book out. This is top-notch scholarship that is solidly researched.

Disclosure: The publisher provided a review copy of this book. The opinion expressed here is my own, however.

Genetics in the Madhouse paperback, hardback, ebook, audiobook or audio CD